高压氧联合微创置管血肿穿刺术治疗高血压脑出血的临床研究

Clinical study on the treatment of hypertensive cerebral hemorrhage with hyperbaric oxygen combined with minimally invasive catheter puncture

目的 观察高压氧（HBO）联合微创置管血肿穿刺术治疗高血压脑出血（HICH）的临床疗效。方法 将122例HICH患者按照治疗方法分为观察组（63例）和对照组（59例），对照组在采用常规治疗的基础上加用依达拉奉和神经节苷脂注射液；观察组在对照组治疗的基础上联合早期HBO治疗。比较2组患者颅内压（ICP）、平均动脉压（MAP）、日常生活能力量表（ADL）分级、神经功能缺损（NIHSS）评分、中风量表（SSS）评分、改良的Rankin量表（mRS）评分及血清丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱氨酸过氧化物酶（GSH-px）水平的变化。结果 （1）2组患者治疗7 d时ICP明显高于治疗后1、14 d（P〈0.01），观察组7、14 d时ICP明显高于对照组（P〈0.05），而2组患者各时间点MAP比较差异无统计学意义（P〉0.05）。（2）2组患者治疗后14 d血清MDA、SOD及GSH-px水平与治疗前比较，差异有统计学意义（P〈0.05或P〈0.01），与对照组治疗后14 d比较，差异有统计学意义（P〈0.05）。（3）2组患者在治疗后7、14、21 d的NIHSS评分均明显低于治疗前（P〈0.01），观察组患者在手术后7、14、21 d的NIHSS评分均明显低于对照组（P〈0.05）。（4）2组患者治疗3个月后随访，观察组ADL分级恢复良好率明显高于对照组（P〈0.01）。（5）2组患者治疗20、30、90 d mRS和SSS评分与治疗前比较，差异有统计学意义（P〈0.01）；观察组治疗90 d后mRS和SSS评分与对照组比较，差异有统计学意义（P〈0.05）。结论 高压氧联合微创置管血肿穿刺术联合早期HBO治疗有助于改善HICH患者的神经功能，提高其生活质量，值得临床推广。

Objective To observe the effects of hyperbaric oxygen （HBO） combined with minimally invasive catheter puncture in the treatment of hypertensive intracerebral hemorrhage （HICH）.Methods One hundred and twenty-two cases of HICH were divided into the observation group （63 cases） and the control group （59 cases）, in accordance with treatment methods. The control group received Edaravone injection and ganglioside injection, in addition to routine therapy, while the observation group received the same treatment as the control group plus HBO. Then, changes in the levels of intracranial pressure （ICP）, mean arterial pressure （MAP） , neurological deficit （NIHSS） scores, daily life ability scale （ADL） classification, stroke scale scores （SSSs）, modified Rankin scale （mRS） scores, serum malondialdehyde （MDA）, superoxide dismutase enzyme （SOD） and glutathione peroxidase （GSH-px） were compared between the 2 groups.Results （1） After treatment, ICP levels at day 7 for the patients in the 2 groups were all significantly higher than ICP levels at day 1 and day 14 （P〈 0.01）, and the ICP levels of the observation group at day 7 and day 14 were significantly higher than those of the control group （P〈 0.05）, and no statistical significance could be seen in MAP levels of the 2 groups at different time points （P〉0.05）. （2） There was statistical significance in the levels of MDA, SOD and GSH-px in the patients of the 2 groups at day 14 after treatment, as compared with those before treatment （P〈0.05 or P〈0.01）. （3） NIHSS scores of the patients in the 2 groups after treatment were significantly lower than those before treatment at day 7, 14 and 21（P〈0.01）. NIHSS scores of the patients in the observation group at day 7, 14 and 21 after surgery were significantly lower than those in the control group （P〈0.05） . （4） Clinical follow-ups after 3 months of treatment indicated that recovery rate of ADL classification of the observation group was obviously higher than that of the control group（P〈0.01）. （5） Statistical significance could be noted in the scores of mRS and SSS at day 20, 30 and 90 for the patients of the 2 groups, as compared with those before treatment （P〈0.05 or P〈0.01）, and at day 90 after treatment, statistical significance could also be noticed in the scores of mRA and SSS scores, when comparison were made between the patients of the 2 groups （P〈0.05）.Conclusions Early HBO combined with minimally invasive catheter puncture plus routine therapy could improve neurological functions of the patients with HICH and the quality of daily life. For this reason it was worth further clinical promotion.